The efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis: a randomized, controlled, double-blind, multi-center clinical trial / 中华普通外科杂志

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.

Multidisciplinary-team approach in diagnosis and treatment of patients with chronic constipation / 中华胃肠外科杂志

Chronic constipation is one of the common diseases in clinic. For the complicated causes and pathophysiology, the overall efficacy is not satisfactory in the traditional medical model. Multidisciplinary-team (MDT) approach is a new team medical model, which is also an important systematic and modular medical approach. Treating patients with chronic constipation by multidisciplinary-team approach is an effective way to improve the overall efficacy. In diagnosis, MDT approach can get more accurate and explicit diagnosis and type of the constipation by gathering patients' detailed medical history, complete physical examination, laboratory and image test, patients' mental and nutritional condition. In treatment, MDT members can cooperate in various fields, such as basic research, medicine, physics, psychology, surgery and conversion therapy, and that may provides more thoughts and methods for the treatment of chronic constipation.

Effects of 5-Aza-2'-deoxycytidine on proliferation of human gastric cancer BCG-823 cells and the expression of HOXA5 gene / 中国医师杂志

Objective To explore the effects of 5-Aza-2'-deoxycytidine (5-Aza-CdR) on the proliferation of BCG-823 human gastric cancer cells and the expression of HOXA5.Methods The methylation status of the promoter of HOXA5 was measured by methylmion specific PCR (MSP).The BCG-823 cells were treated with different concentrations of 5-Aza-CdR,and then the changes of expression and methylation status of HOXA5 gene were detected by quantitative real-time polymerase chain reaction (QRT-PCR),Western-blot,and MSP.Cells proliferation was assessed by methyl thiazolyl tetrazolium (MTT) assay.Results (1) Different methylation status of HOXA5 gene promoter was detected in BCG-823 cells.The mathylation rate of HOXA5 gene promoter were reduced after treatment with 5-Aza-CdR,and also were negatively related to the concentration of 5-Aza-CdR (F =438.307,P ＜ 0.01).(2) Compared to the control groups,the expressions of HOXA5 mRNA and protein were increased after treatment with 5-Aza-CdR,with statistical significance (P ＜ 0.05).(3) The proliferation rate of BCG-823 cells was significantly inhibited (P ＜0.05).Conclusions The methylation status of HOXA5 promoter was detected in BCG-823 cells.5-AzaCdR is able to inhibit BCG-823 cells growth in vitro,which might be related to the expression of HOXA5.It may be a new way to treat gastric cancer.

Preliminary exploration on accurately preoperative evaluation of colonic lesions in slow transit constipation complicated with adult megacolon / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the application value of colonic transit test (CTT) combined with anorectal manometry (ARM), barium enema (BE) and defecography (DFG) in accurately evaluating colonic lesions of slow transit constipation complicated with adult megacolon.</p><p><b>METHODS</b>Clinical data of 47 above patients admitted between October 2007 and February 2015 in the People's Hospital of Hunan Province were analyzed retrospectively. All the patients were examined with≥2 times of CTT combined with ARM and BE, and 42 cases received additional DFG at the same time, to evaluate colonic lesions before operation. Operative biopsy pathology was used as the standard. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of positioning in the ascending colon and caecum, transverse colon and descending colon were calculated, and the consistency was represented by Kappa test(Kappa value≥0.75 indicates good consistency, meanwhile higher Kappa value indicates better consistency). The Heikkinen score was used to evaluate defecation function at postoperative 6 months.</p><p><b>RESULTS</b>The age of 47 patients was from 18 to 56 years old. Compared with intraoperative findings and biopsy pathology, the diagnostic coincidence rate was 89.4% by CTT combined with BE and DFG positioning, which suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=12), transverse colon (n=26) and descending colon (n=9), while intraoperative findings and biopsy pathology suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=11), transverse colon (n=23) and descending colon (n=13). The sensitivity was 88.3%, specificity 93.5%, PPV 92.1%, NPV 94.9% and Kappa value was 0.827(P<0.001). Procedures performed included segmental colectomy (n=8), subtotal colectomy (n=29), total colectomy (n=10). There was no serious complication during and after operation. Defecatory function was excellent in 24 cases (60.0%), good in 10 (25.0%), and moderate in 6 (15.0%) evaluated by Heikkinen score at postoperative 6 months. A total of 40 patients were followed up from 1 to 7 years (median 3 years) and there was no long-term diarrhea and recurrence of constipation or giant colon after operation.</p><p><b>CONCLUSION</b>Preoperative detection of CTT combined with ARM, BE and DFG in patients with slow transit constipation complicated with adult megacolon can make a more precise assessment of the extent of colonic lesions in advance, which has a good clinical predictive value.</p>

Standardization and implementation of operation for slow transit constipation / 中华胃肠外科杂志

Slow transit constipation (STC) is one kind of chronic constipation. Medical treatment is adopted by most patients, but many patients do not respond to conservative treatment and require surgical intervention. There are several problems in clinical paratice, including non-rigorous patient selection, less standard preoperative assessment, less standard operation or insufficient post operative treatments and follow-up, which may lead to the overtreatment or serious complications. As the changes of living habits and diet, the incidence of STC increases gradually. Therefore it is important to make a standardized surgical treatment of STC. Because lots of factors may cause STC and the pathophysiology of STC is complicated, multidisciplinary treatment is recommended. This paper will discuss the standardized surgical treatment of STC base on the new literature and author's experience, concerning operative indications, preoperative assessment, choice of operation procedure, postoperative evaluation and follow-up.

Toxic megacolon induced by primary ulcerative colitis / 中华普通外科杂志

Objective To analyze the clinical manifestations and treatment for toxic megacolon induced by drastic cathartics inpatients with an unknown history of ulcerative colitis. Methods The clinical data of 5 patients with toxic megacolon induced by ulcerative colitis with initial onset type from June 2003 to October 2008 were analyzed retrospectively. Results In 5 cases, the first symptom was abdominal pain and distention. After taking cathartics, these 5 cases were complicated with toxic megaeolon and 2 cases suffering from intestinal perforation. Four female patients suffered from transient unconsciousness, in which 3 patients were found with cerebral lacunal infarction identified by magnetic field diffusion-weighted imaging. All 5 cases underwent exploration, colectomy and ostomy, one patient died perioperatively, anastomotic fistula and anastomotic constriction developed in one each cases. Conclusions The most common clinical manifestations of toxic megacolon induced by ulcerative colitis are abdominaigia, abdominal distention. Emergency therapeutic strategy consists of partial culectomy and ostomy.

Expression and significance of smad_4mRNA,TGF-?_1 ,and TGF-?R_1 in pancreatic carcinoma / 中国普通外科杂志

Objective To study the significance of expressions of smad_4mRNA,TGF-?_1, and TGF-?R_1 in pancreatic carcinoma(PC) . Methods Smad_4mRNA was detected by in situ hybridization. TGF-?_1 and TGF-?R_1 were detected by immunohistochemical method. Results The positive rates of smad_4mRNA,TGF-?_1 and TGF-?R_1 were singnificantly lower in 53 slices of pancreatic carcinoma than those in 25 slices of paracancerous tissue (all P